Last month nine out of 10 patients ambulanced to the QEII Health Sciences Centre Emergency Department waited more than six hours to be admitted. Six hours and 42 minutes, in fact.
That disturbing information is contained in the Ambulance Offload Times report for last month prepared for Nova Scotia Health (NSH) and submitted to the Health minister. It confirms what many already knew: the situation on the front lines is getting worse.
Former Health Minister Zach Churchill became alarmed last April when it was clear overcrowded emergency departments were creating a bottleneck. More and more ambulances were unable to respond to new calls because they were tied up outside the emergency department waiting to discharge patients. The grieving families of Kelly MacPhee and April George have spoken out publicly about their frustration watching loved ones die waiting for an ambulance to show up.
The target or benchmark set by the province is 30 minutes to off load 90% of patients arriving at emergency departments. After 30 minutes, the paramedic/ambulance driver is supposed to be free to respond to another call.
That goal increasingly looks like a cruel fantasy. The situation at the Halifax Infirmary has even deteriorated since June, when patients being transported by ambulance waited four hours in the parking lot or in the hospital corridor. We’ll look at the factors contributing to those numbers in just a moment.
The data in the August report show all four health zones across the province saw an increase in the wait time for ambulances at emergency departments.
At Colchester East Hants Health Centre in Truro, nine out of 10 ambulances waited more than three hours at Emergency. In June that would have been a two-hour wait. At Cape Breton Regional Hospital, the wait time was one hour and 20 minutes, or nearly three times the half-hour benchmark. The South Shore Regional Hospital in Bridgewater reported nine out of 10 patients waiting two hours to be admitted to its emergency department.
Wait times to deliver patients into care were even longer across the Halifax Regional Municipality.
During the first three weeks of August, ambulances waited four hours to offload patients at the Cobequid Community Health Centre in Sackville. Cobequid ER nurse manager Jamie Stewart described working conditions “as a war zone” in a recent interview with The Current on CBC Radio. Stewart described one night early in September when the 30 beds were full, 44 patients were in the waiting room, and eight ambulances were lined up outside. The Sackville community health centre isn’t supposed to be open after midnight, but the same tired staff continued to work through to the next day to handle the backlog of patients.
Meanwhile at the Dartmouth General Hospital, paramedics averaged more than three hours (185 minutes) waiting to discharge their patients. On August 10, 86-year-old Ross O’Brien of Dartmouth fell and broke his hip, then waited three agonizing hours for an ambulance to arrive.
“Code Critical” is the hashtag used by paramedics to indicate an area is without an ambulance — a phrase repeated several times a day during August. Both Nova Scotia Health and the unions involved suggest the most probable explanation for increased wait times outside emergency departments is a combination of summer vacations and “an unprecedented shortage of nurses.” That leaves large areas of the province without coverage in the event of a heart attack or car accident.
“There is a shortage of paramedics,” said Michael Nickerson, the president of the Nova Scotia Paramedics union (IUOE Local 727). He estimates as many as 200 are out on disability or stress leave. “But a bigger problem is the shortage of nurses combined with the lack of access to family doctors and people occupying beds in hospitals because they are waiting to get into long-term care (nursing homes).”
Nickerson believes the dramatic increase in offload times at the Halifax Infirmary last month was because there weren’t enough nurses available to staff all the “pods” or units at the hospital. In mid-July, Nova Scotia Health vice-president Colin Stevenson confirmed to CBC News that some services might have to be cut because hospitals were so short of registered nurses. Stevenson said summer began with 20% of nursing positions unfilled across the province. Nova Scotia Health estimated as many 200 RNs and LPNs had left jobs in hospitals to help public health with vaccinations and contact tracing.
In HRM alone, there were 19 vacancies for emergency department personnel that weren’t expected to be filled until September. The Examiner asked NSH for its explanation for the increase in ambulance offload times, particularly in Metro. Here’s a response from Brendan Elliott, senior communications manager for NSH.
Ambulance offload times are influenced by many factors, including emergency department volumes, the number of admitted patients within the health system, the number of hospital inpatients who would be better served in another setting, and overall staffing levels. Over the past several months, Nova Scotia Health – much like other health systems across North America – has experienced very high demand for service, with increased visit volumes and increased admissions to our emergency departments.
This increase has been experienced at a time when we have also been facing significant workforce challenges. In addition, overcrowding in emergency departments is a symptom of difficulties transferring patients elsewhere in the system, whether it’s into long term care or another setting in the community…Nova Scotia Health is committed to working every day to improve access and flow across the system, including timely offload of ambulances.
Will nurses return or not?
As vaccination clinics ramp down, Nova Scotia Health is hoping nurses will return to work in hospitals. But union leaders have suggested people are quitting or retiring because they are tired and there aren’t enough of them to provide the care required for critically ill patients during a pandemic. In Quebec, the government of Francois Legault is offering nurses $12,000 to 18,000 bonuses if they will come back to work full-time.
After a series of meetings around the province, Premier Tim Houston acknowledged on Friday the ongoing and worsening delays for paramedics who are waiting to offload patients at hospital emergency departments. “Many of the health-care providers we spoke with mentioned our ambulance system as a key area for improvement,” Houston “Suggestions to free up front-line staff from non-emergency tasks like routine transfers is something we can do in the short-term. This will alleviate pressure and ensure our paramedics can focus on the emergency care people need quickly when they call 911.”
The van plan
Let’s hope so. Since April, the province has bought three Ford Transit vans for a pilot project to see if more patients who are not critically ill can be transported in a vehicle other than an ambulance between hospitals for tests and medical appointments. Finding a different vehicle for moving non-urgent cases was a key recommendation contained in the Fitch Report delivered to the Liberal government in 2019. The report found paramedics spent 47% of their time driving non-urgent cases between hospitals instead of responding to actual life or death emergencies.
The Progressive Conservative government is considering buying more vehicles to relieve some of the pressure on paramedics. However, the current criteria for the pilot project may be flawed since it limits how many patients can use the service.
The driver of the van is trained in CPR and first aid, but patients must be capable of walking or using a wheelchair, because the driver leaves once patients get dropped off. Many residents of long-term care facilities are too frail to walk so the vans saw limited uptake from nursing homes in the early days of the pilot project. Emergency Health Services has also added medical staff to its communications centre to triage incoming calls and offer alternatives — such as calling 811 for medical advice or the mental health crisis line — in situations where an ambulance may not be the appropriate response.
As a premier who campaigned on a promise to “fix health care,” Tim Houston didn’t have to wait long before being tested by the challenge of long waits.